How COVID-19 affects children

Remember the good old days of February 2020, when the biggest challenges facing the average parent were screen time and sibling squabbles? Well, they're long gone. Parenting in the time of COVID-19 involves saying "Have you washed your hands?" on repeat, tying their (clean) hands behind their backs to stop them touching their faces all the time, and trying to explain what a global pandemic is without freaking them (and yourself) out.

If you're worried about your kids getting the coronavirus, that's completely normal. This is unchartered territory for all of us. But the information available so far indicates that COVID-19 appears to primarily affect adults, says pediatrician Mahmoud Loghman-Adham, M.D., who is a principal at California-based life sciences consulting firm Innopiphany. "Children under 19 years represented only about 2.1 percent of cases reported from China, [the early epicenter of the outbreak]," Loghman-Adham adds. His view? "Parents shouldn't be unduly concerned about their children contracting this disease."

What about the findings of a recent study, published in Pediatrics, claiming that a small percentage of kids who get COVID-19 can become seriously ill? "Younger children, and infants in particular, are more susceptible to serious illness," Loghman-Adham says. "In this particular study, 10.6 percent of infants under 12 months had severe or critical illness from the coronavirus, compared to 3 percent of those 16 years and older."

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But parents need to remember that children seem to represent a small proportion of those who get ill from the coronavirus, he adds. In another recent publication — from the COVID-19 response team at Imperial College, London — it was estimated that only 0.4 percent of children age 19 and younger develop symptoms requiring hospitalization, compared to 51.6 percent of those 70 years and older.

"Parents should understand that the risk that their children could become seriously ill from COVID-19 is very low," Loghman-Adham says. And most importantly, if they contract the disease, almost all of them will recover.

Scientists are still trying to figure out why kids are less likely to be affected by the coronavirus than adults. "One possible reason is that the virus (SARS-Cov-2) can't stick to their lung tissue, which is less mature than adults'," Loghman-Adham says.

Why younger children, and infants in particular, develop more serious illness from COVID-19 is another unknown. "We do know that in winter months infants are susceptible to other viral infections such as respiratory syncytial virus (RSV), which renders them more susceptible to further infections," Loghman-Adham says. Of course, if a child has a serious illness like heart disease or cancer, or has a compromised immune system (after a transplant, for instance), this could increase the likelihood of developing a more serious infection from the coronavirus. In those cases, avoiding exposure to the general population is a crucial preventative measure.

The symptoms of COVID-19 are similar in children and adults, says the Centers for Disease Control and Prevention (CDC). While the most common symptoms in adults are fever, persistent cough, and shortness of breath, symptoms reported in kids also include runny nose, vomiting, and diarrhea.

A paper published March 13 in Nature Medicine supports the position that COVID-19 is rarely severe in children. Admittedly, the study was small — it looked at 10 kids in China, between the ages of two months and 15 years, who had confirmed positive diagnoses and were admitted to a treatment center — but it found that none of the kids experienced headaches or muscle aches (as reported in many adult patients). Nor did any of the kids have solid signs of pneumonia, which has been identified in severe cases in adults.

The CDC upholds that children with confirmed cases of the coronavirus have generally presented with mild symptoms. That's good news for our kids. But it's important to remember that even if they have no symptoms at all, kids can still spread the virus to others. That's why otherwise healthy kids who show no signs of having COVID-19 still need to be doing some level of social distancing (the CDC recommends staying at least six feet away from anyone who is coughing or sneezing, for starters) as well as all that hand-washing (often and thoroughly, using soap and water) and non-face-touching you've been nagging them about.

There's a lot we still don't know about kids and COVID-19. But what we do know should help to ease the worry, at least a little.

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